Point prevalence probing of antimicrobial prescription patterns from a developing country

ABSTRACT

Background

Irrational use of antibiotics intensifies resistance and jeopardizes advances made in modern medicine. We aimed to conduct a baseline gap analysis survey on antibiotic prescription practices across Pakistan.

Research Design and Methods

This multi-centered cross-sectional survey was conducted at six public sector tertiary care hospitals from February 2021 to March 2021. Data related to various variables including hospital infrastructure, policies and practices, monitoring and feedback, and epidemiological, clinical, and antibiotic prescription for surveyed patients was collected using World Health Organization (WHO) Point Prevalence Survey (PPS) methodology.

Results

In a survey of 837 inpatients, 78.5% were prescribed antibiotics. Most commonly prescribed antimicrobial was ceftriaxone (21.7%), followed by metronidazole (17.3%), cefoperazone-sulbactam (8.4%), amoxicillin-clavulanate (6.3%), and piperacillin/tazobactam (5.9%). Surgical prophylaxis (36.7%) and community-acquired infections (24.7%) were the main reasons for antibiotic prescriptions. Single antibiotics were given to 46.7% of patients, 39.9% received a combination of two antibiotics, and 12.5% were prescribed three or more antibiotics. Among six hospitals surveyed, two had drug and therapeutic committees, three had infection prevention and control committees, and one had an antibiotic formulary.

Conclusion

Findings demonstrate high consumption of broad-spectrum antimicrobials and emphasize the importance of expanding antimicrobial stewardship programs among hospitals. Mentoring clinical teams could help rationalize antimicrobial use.

KEYWORDS:

• Antimicrobial resistance
• antimicrobial use
• antimicrobial stewardship
• low middle-income country
• WHO AWaRe classification of antibiotics
• Point Prevalence Survey

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethical considerations

Exemption for ethics approval was granted by the Institutional Review Board of Indus Hospital and Health Network, Karachi. (IRD_IRB_2021_03_004). The ethical exemption was also granted by the six participating hospitals subsequently. All collected data were anonymized during the time of data collection.

Author contributions

All authors contributed significantly to this paper. All authors participated in several meetings at different stages, contributed to the papers’ successful completion, and discussed implantation and analysis. N Khursheed, M Fatima, S Jamal, S Tariq, T Mustafa, and Q Ahsan conceptualized the study. N Khursheed, M Fatima, S Rattani, and S Jamal supervised all stages of the study with support from K Ahmed, A Raza, and S Iqbal. N Khursheed, S Jamal, and M Fatima supervised the implementation and data collection at all sites. M Fatima and K Ahmed supervised implementation and data collection in Karachi supported by G Fatima and S Masroor Ahmed. S Iqbal and S Rattani supervised implementation and data collection in Punjab supported by S Zulfiqar and R Altaf Ahmed. A Raza and S Jamal supervised the implementation and data collection supported by F Ullah and S Akbar Khan in Gilgit and Peshawar. M Fatima, S Rattani, A Raza, and K Ahmed contributed to data curation and validation. S Rattani did the formal analysis and drafted the initial draft. All authors edited and approved the final version of the manuscript.

Acknowledgments

The authors would sincerely like to thank the whole study team at Indus Hospital and Health Network and DAI, Pakistan. They would also like to acknowledge the departmental heads and focal persons of the laboratory and wards participating in the Fleming Fund clinical engagement program of the surveyed hospitals (Dr Ruth K. M. Pfau Civil Hospital Karachi; Hayatabad Medical Complex, Peshawar; Jinnah Postgraduate Medical Centre, Karachi; Nishtar Medical University Hospital, Multan; Provincial Head Quarter Hospital, Gilgit, Gilgit- Baltistan and Shaikh Zayed Medical Complex, Lahore).

Some of the results and data were presented as an oral presentation at 19^th Annual Medical Microbiology and Infectious Diseases Society of Pakistan (MMIDSP) Conference held from 19^th to 21^st May 2022 in Pakistan. Some results were also presented as a poster as part of the International Congress on Infectious Diseases (ICID) held from 17^th to 20^th November 2022 in Kuala Lumpur, Malaysia and 7^th World One Health Congress 2022 held from 7^th to 11^th November 2022 in Singapore.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14787210.2023.2259098

Additional information

Funding

This manuscript was funded by the Fleming Fund Country Grant Pakistan.